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PT2 Psyche 1-6 > Schizo pharmacology > Flashcards

Schizo pharmacology Flashcards

1
Q

Positive symptoms

A
  • hallucinations
  • delusions (persecutory, grandiose)
  • bizarre behavior (social, sexual, aggression)
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2
Q

negative symptoms

A
  • affective flattening or blunting
  • alogia (lack of speech)
  • avolition (lack of motivation)
  • anhedonia (lack of pleasure)
  • poor grooming
  • social withdrawal
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3
Q

cognitive symptoms

A
  • poor information processing
  • attention deficits
  • working memory deficits
  • thought disorders (derailment, tangentiality)
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4
Q

catatonia

A
  • rare in developed world
  • patients seem lifeless, muteness
  • associated with social withdrawal
  • muscle rigidity in weird positions
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5
Q

diagnosis of schizophrenia

A

at least two of the following for >6 months:

  • delusions
  • hallucinations
  • disorganized speech/thoughts
  • disorganized or catatonic behavior
  • negative symptoms
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6
Q

if schizophrenia symptoms last for < 1 month its called

A

brief psychotic episode

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7
Q

if schizophrenia symptoms last for >1 month but less than <6 monthss

A

schizophreniform disorder

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8
Q

typical spectrum premorbid signs and symptoms

A

(0-10 yo)

  • quiet, passive, introverted personality
  • avoidance of social activities
  • in some cases, spells of OCD
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9
Q

prodromal signs and symptoms

A

(10-20 yo)

  • decline in occupational and interpersonal functioning
  • sudden development of interest in abstract ideas
  • bizarre behavior and unusual speech
  • poor grooming, depression
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10
Q

good prognosis for schizophrenia

A
  • late onset
  • obvious precipitating factors
  • acute onset
  • good premorbid history
  • married
  • family history of mood disorders
  • positive symptoms
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11
Q

poor prognosis for schizophrenia

A
  • early onset
  • no precipitating factors
  • insidious onset
  • poor premorbid history
  • single, divorced or widowed
  • Fx of schiozphrenia
  • negative symptoms
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12
Q

physical changes in the brain in schizophrenia

A

thinning of the prefrontal cortex and enlargement of lateral ventricles

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13
Q

neurochemical deficits in schizophrenia

A
  • low function of NMDA receptors
  • overactivation of D2 in nucleus accumbens
  • low activation of dopamine in prefrontal cortex
  • overactivation of 5-HT2A receptors
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14
Q

NMDA antagonists cause what schizophrenia like symptoms

A
  • positive
  • negative
  • cognitive
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15
Q

role of NMDA receptors in the brain

A

filter information via pyramidal neurons and interneurons

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16
Q

dysfunction of NMDA receptors leads to

A
  • loss of sensory coherence in perceptions
  • positive, negative, and cognitive symptoms
  • HALLUCINATIONS*
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17
Q

auditory hallucinations and cognitive deficits originate from

A

hyperactivity of the temporal cortex

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18
Q

dysfunctions of the prefrontal cortex lead to

A
  • improper interpretation of environmental stimuli
  • decision making
  • recognition of social cues and facial expressions
  • attention and working memory
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19
Q

which schizophrenic symptoms are associated with the prefrontal cortex

A

negative symptoms due to NMDA receptor dysfunction

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20
Q

dorsolateral prefrontal cortex role

A

processing of abstract rules and logical interpretation

21
Q

cognitive deficits due to

A

dysfunction of NMDA receptors and activatino of 5-HT2a receptors in dorsolateral prefrontal cortex

22
Q

salience

A

dopamine driven motivational function that is directed towards things relevant to you, to which you have an emotional charge.

23
Q

role of dopamine in positive symptoms

A

hyperactivation of mesolimbic system leads to high dopamine in nucleus accumbens which causes the symptoms

24
Q

main target of antipsychotic drugs

A

D2 antagonism in nucleus accumbens – positive symptoms

25
Q

difference between typical and atypical antipsychotics

A

typicals are D2 selective while atypicals hit multiple receptors

26
Q

high potency typical antipsychotics

A 
(1-20 mg/day)
haloperidol
fluphenazine
droperidol
pimozide
27
Q

mid potency typical antipsychotics

A

(10-100 mg/day)
loxapine
perphenazine
thiothixene

28
Q

multi-acting receptor targeting agents (atypical)

A

clozapine
olanzapine
quetiapine

29
Q

serotonin 2 - dopamine 2 antagonists (atypical)

A

risperidone
paliperidone
ziprasidone

30
Q

dopamine partial agonists (atypical)

A

aripiprazole
brexpiprazole
cariprazine

31
Q

4 effects of typical antipsychotics

A
  • antipsychotic
  • extrapyramidal side effects
  • antiemetic effect
  • hypothermia
32
Q

extrapyramidal side effects

A
  • parkinsonism
  • akathisia
  • acute dystonia
  • tardive dyskinesia
33
Q

prolonged antagonism of D2 receptors causes

A

increased prolactin release (gynecomastia in men, galactorrhea in women)

34
Q

management of parkinsonism

A
  • lower antipsychotic dose if possible
  • change to atypical
  • treat with anticholinergic
35
Q

akathisia

A

-restlessness, fidgeting, jitteriness

36
Q

management of akathisia

A
  • lower dose if possible
  • change to atypical
  • treat with propranolol or benzo
37
Q

acute dystonia

A

painful muscle spasm in head and/or neck

38
Q

acute dystonia treatment

A

IM benztropine or diphenhydramine

39
Q

tardive dyskinesia

A
  • involuntary movements of face and tongue
  • usually appears after prolonged use
  • caused by up-regulation of dopamine receptors
40
Q

neuroleptic malignant syndrome

A
  • fever, muscle rigidity, delirium
  • muscle breakdown
  • caused by high doses or highly potent drugs
41
Q

management of neuroleptic malignant syndrome

A
  • stop the drug
  • give dantrolene
  • supportive measures
  • bromocriptine
42
Q

reason we don’t have NMDA agonists

A

would induce seizures

43
Q

clozapine MoA

A

blocks D4 receptors and partial NMDA agonist

44
Q

clozapine use

A
  • for positive and negative symptoms

- reduces suicidality and aggression

45
Q

clozapine side effects

A
  • agranulocytosis
  • risk of seizure
  • weight gain
  • sedation
46
Q

clozapine monitoring

A

weekly blood drawing to check granulocyte counts

47
Q

cons of atypical antipsychotics

A
  • cognitive side effects
  • arrhythmias
  • potential seizures
  • cost
  • metabolic syndrome
48
Q

general side effects of antipsychotics

A
  • anticholinergic
  • orthostatic hypotension
  • sedation
  • hunger
  • hyperglycemia
49
Q

things that can cause schizophrenic-like symptoms

A
  • drug abuse and withdrawal
  • prescription drugs
  • toxic agents
  • neurologic causes
  • metabolic causes
  • vitamin deficiencies

PT2 Psyche 1-6 (6 decks)

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